There are currently two approaches to restraining the growth of Medicare spending in Washington. One, espoused by the Obama administration, is to create an Independent Payment Advisory Board which will prevent Medicare from paying for ineffective health care treatments. The other, espoused by House Republicans, is to do nothing whatsoever for the next ten years. And then to promise that nothing will ever be done to harm a precious hair on the head of a single precious person born in the good old days before 1955.

But if you were born after 1955? Then it’s simple—no Medicare for you. You get a coupon, of decreasing value, to go buy private health insurance.

Sometimes conservative pundits claim to believe that the problem with the IPAB approach is that it can’t be made to work. Other times conservative politicians dedicate themselves to fanatical defense of wasteful Medicare spending, denouncing IPAB as Kenyan socialist rationing. And Brian Beutler reports that they have a powerful tool to make sure IPAB fails—just don’t confirm anyone:

There’s just one problem: Each of the board’s 15 members has to be confirmed by the Senate. That means filibusters and 60 vote requirements stand in the way of staffing a panel that Republicans decry as a government rationing board. And months ahead of the nominations, they’re telling Obama “good luck with that!”

“I think it would be pretty tough,” Sen. Orrin Hatch (R-UT), the top Republican on the powerful Senate Finance Committee, told TPM Monday, when asked about confirming Obama’s nominees to IPAB. “We don’t believe in rationing, nor do we believe in an unaccountable organization like that. I mean that’s crazy.”

“I’d have to think about that. If it were changed, then probably, but the way it’s constituted now, it’d be difficult,” Sen. Tom Coburn (R-OK), an influential conservative in the Republican caucus, said Monday in response to a question from TPM.

Then once this effort to increase the cost-effectiveness of Medicare for all Americans is sabotaged, the success of the sabotage will become an argument in favor of scrapping Medicare altogether.